New Diet to Cut Acid Reflux

Think heartburn and indigestion are the only signs of acid reflux? Turns out that nagging cough or hoarse throat could signal the condition too. In this exclusive interview, we ask a leading medical expert to share symptoms, treatments and recipes for relief….

About 100 million Americans have acid reflux, a condition in which contents of the stomach back up to the esophagus or higher. But more than half don’t realize it, says Jamie Koufman, M.D., F.A.C.S., founder and director of the Voice Institute of New York, a treatment center for reflux and other conditions that affect the voice.

One reason, says Koufman – an authority on acid reflux, as well as a sufferer – is that some experience atypical, “silent” symptoms, such as coughing or postnasal drip. As a result, they and their doctors assume they’re suffering from allergies or sinus problems.

Diet changes, as well as medication, are effective treatments for the condition.

In her new book, Dropping Acid: The Reflux Diet Cookbook & Cure, Koufman teams with ear, nose and throat surgeon Jordan Stern, M.D., and French chef Marc Bauer to introduce a healthy eating plan for people with acid reflux.

In this exclusive interview, Koufman shares clues you might miss, how to get help and low-acid recipes to get symptoms under control.Why do so many people have acid reflux?One reason is higher levels of acid in most foods we eat, especially those that are bottled or canned.

In the 1970s, the Food and Drug Administration raised the levels of acid in prepackaged foods to discourage bacterial growth and prolong shelf life. But they failed to anticipate the adverse health consequences [on people].

Today, some prepared foods and beverages are as acidic as stomach acid itself. Who’s likely to develop it?Research suggests a link between being overweight and developing acid reflux, but I’ve seen many patients at a normal weight or even very thin who also suffer from it.

And while we once thought this was a disease that only struck older people, we’re seeing more in their 20s and 30s with the condition.Can you explain the “silent” symptoms people can get?Silent, or atypical, acid reflux can cause symptoms such as coughing (including a dry cough), chronic throat clearing, and the sensation of having something stuck in your throat.

Many sufferers also have postnasal drip and have been told their symptoms are abnormal nasal drainage, infections or sinus problems.

The medical term I coined for this is laryngopharyngeal reflux (LPR). It results when hydrochloric acid [the main component of the stomach’s gastric acid] backs into your throat, voice box and nasal cavity.

That’s opposed to gastroesophageal reflux disease (GERD) [a severe form of acid reflux], in which acid flows back into your esophagus. How does LPR differ from GERD?GERD's main symptom is heartburn. Although some LPR sufferers complain of that, it isn’t common [among them].

While there’s a link established between GERD and being overweight, many of the LPR patients I’ve treated aren’t obese – though they often have poor dietary habits.Why is LPR so hard to diagnose?General practitioners often confuse it with a sinus or allergy problem, since patients don’t have heartburn or indigestion.

If you have chronic symptoms that haven’t responded to sinus, allergy or gastrointestinal treatments – and have had other diagnostic tests done to no avail – I recommend consulting an ear, nose and throat doctor (ENT). They can look at your voice box and throat to determine if you have inflammation consistent with LPR.

I see many patients who’ve consulted many doctors – allergists, gastroenterologists and other specialists – yet still haven’t received a diagnosis or relief for their symptoms. It can be very frustrating.

Women need to be their own health advocates and push for a referral to an ENT (also known as an otolaryngologist). If you think you have acid reflux, when should you seek medical treatment? Many women experience occasional heartburn or hoarseness. But if symptoms persist, occur more than twice a week or interfere with sleep or daily life, consult your doctor.How is acid reflux treated?Many cases can be effectively treated by diet modification.

For some people, a histamine-2 blocker – over-the-counter medication such as Tagamet [cimetidine], Zantac [ranitidine] or Pepcid AC [famotidine; all three suppress stomach-acid secretion] – can help ease symptoms.

In more severe cases, a doctor might prescribe a proton pump inhibitor such as Prilosec [omeprazole], Prevacid [lansoprazole] or Protonix [pantoprazole; these medications halt almost all stomach acid].

There are several minimally invasive surgery options available to patients who don’t respond to medications.You used to suffer from acid reflux. How did you find relief?I had also developed a pre-cancerous lesion on my vocal cords, so I underwent reflux surgery [which reinforces the barrier between the esophagus and stomach] in 1998.

Since then, I’ve modified my diet and practice self-discipline. I still have flare-ups if I don’t watch what I eat.

There was one evening where I enjoyed a late dinner with friends, complete with cocktails and a chocolate dessert. It took me 2-1/2 weeks to recover.How does the diet plan in your book counteract symptoms?It starts with a 2-week, strict, acid-free diet, a kind of digestive system detox program. It includes no fruit, except bananas and melons, and the main beverage is water – at least eight cups a day, non-carbonated.

More than half my patients have seen great relief after this period.

Then certain foods can be added back in. I recommend people keep a food diary to see if any of these new items trigger symptoms.

Here are three recipes from Dropping Acid: The Reflux Diet Cookbook & Cure:

2. Place lemon and rosemary on the filet and drizzle ¼ tsp of the olive oil. Season with salt as needed.

3. Wrap each filet in foil and place in a baking pan in the oven at 350°F for 10-15 minutes.

4. To serve: Remove from oven, unwrap foil, remove the lemon (do not squeeze it on the filet) and the rosemary.

5. Serve with rice and your favorite steamed greens.Notes: Prep time is about 5 minutes for the salmon. The tightly wrapped foil allows the filets to steam. The rosemary (or other herbs of your choice) and the slice of lemon impart great flavor. Since you’re not squeezing the lemon on the fish, you can avoid its acidity while enjoying the flavor – especially from the lemon skin that steams along with the filets.You can leave out the olive oil drizzle if you prefer.For accompanying vegetables, I usually steam asparagus, broccoli or spinach.

4. Place the olive oil in a pan over high heat, add the sweet potatoes, and cook until golden brown on all sides.

5. Place the sweet potatoes in a bowl and add the green beans, lemon zest, and the maple and pineapple dressing. Toss until mixed.

6. Place the arugula (or watercress) on the bottom of a plate and the vegetables on top. Sprinkle with the toasted sesame seeds.

7. Serve immediately.Notes: It is important to chill the green beans in ice-cold water immediately after cooking or they will lose their bright green color. Mixing the dressing with the sweet potatoes while they are still warm allows even distribution of the dressing throughout the salad.The salad should be served at room temperature. If potatoes are too warm, the watercress will wilt.

4. Preheat a nonstick pan over low to medium heat. Wipe a paper towel that has been rubbed with butter on the pan's bottom. (Remove excess butter with the same paper towel and use again before cooking next pancake.)

8. Serve with maple syrup; can be topped with diced apples.Notes: I like to use Canadian D-grade maple syrup (equivalent of grade C in the U.S.) for its darker color and stronger flavor.

Cooking in a non-stick pan allows you to use butter sparingly.You can make your own oat flour by blending rolled oats in a food processor or blender until fine.If you make the batter the night before, don’t add the baking powder until just before cooking. This batter will be slightly darker, but the result will be just as delicious. Adding a tiny bit of diced mango to the batter just before cooking gives these pancakes a great flavor and pleasing color.

Nutrition Facts Per serving:220 calories7g protein36g carbohydrates7g fatFor more recipes and information about the book, visit the Reflux Cookbook website.To learn more about acid reflux, visit our Heartburn/GERD Health Center.What’s Your Indigestion IQ?Far too many of us are familiar with the lingering discomforts associated with indigestion, heartburn, acid reflux, and other gastrointestinal issues. The good news is that you can take steps to prevent the unnecessary side effects brought on by certain behaviors. It's all about keeping your stomach happy. Do you know how? Take this indigestion quiz to find out.

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